GOVERNMENT OF RAJASTHAN
FINANCE (INSURANCE) DEPARTMENT
No. 5(5)FD/Insurance/2020 Jaipur, dated: 09.04.2021
The Governor is pleased to introduce a Cashless Health Benefit Scheme hereinafter referred as Rajasthan Government Health Scheme (RGHS) to cover indoor medical treatment expenses, specified day-care procedures, outdoor treatment, investigations and medical attendance and treatment under Ayurveda, Homeopathy, Unani Chikitsa Paddhati and other treatment as specified or to be specified by State Government. The scheme will cover compulsorily the Ministers, All India Service Officers, MLAS & Ex-MLAs, Serving & Retired Judicial officers, Serving Government employees (whether covered under old or new pension scheme) and pensioners / family pensioners. Also, this scheme will be applicable for the employees and pensioners of Autonomous Bodies, Boards, Corporations etc. The contribution to the Scheme will be decided by the State Government in due course.
2. The RGHS will cover all the medical facilities as per conditions and procedures laid down under the respective rules / schemes of different categories viz. (i) The Rajasthan Ministers (Medical Attendance) Rules, 1961 (ii) Rajasthan Judicial Officers (Medical Facilities) Rules, 2008 (ii) All India Services (Medical Attendance) Rules, 1954 (iv) The Rajasthan Legislative Assembly Members (Medical Facilities) Rules, 1964 (v) Rajasthan Legislative Assembly Ex Members and Family. Pensioners (Medical Facilities) Rules, 2010 (vi) Rajasthan Civil Services (Medical Attendance) Rules, 2013 (vii) Rajasthan State Pensioners’ Medical Concession Scheme, 2014 and (viii) Raj Mediclaim Policy.
3. New beneficiaries will be allowed for treatment up to Rs. 5.00 Lacs per year on family floater basis. The scheme shall cover additional expenses relating to hospitalization of beneficiary member above Rs. 5.00 Lacs per family per year in any of the Government/Private empanelled hospital, specifically for catastrophic illness.
4. The treatment can be taken in any Health Care Network Provider (HCNP) i.e. Government hospitals, approved hospitals, PPP hospitals, Referral hospitals (after due reference from competent authority). The reimbursement to TPA will be allowed as per RGHS rates. No reimbursement will be allowed to RGHS Card holder, where cashless treatment is available. However, reimbursement can be taken by the RGHS Card Holder for medical treatment taken in grave emergency in un-approved hospital and in other exceptional circumstances. In such circumstances, the claim will be reimbursed only after submitting the bills on RGHS Portal. Further details in this regard can be seen on RGHS website i.e. rghs.gov.in
5. There are certain treatments which are not covered under RGHS. Details of such exclusions will be available in the scheme uploaded on the website of RGHS. The reimbursement of such exclusions will not be made through Third Party Administrator (TPA).
6. The State Government will select TPA through RTPP Act and Rules.
7. Enrollment of beneficiaries under this scheme will start from 10-4-2021 and will be completed by 30-04-2021. Every person of above mentioned category will ensure his/her enrollment along with dependents before 30-04-2021 enabling State Insurance and Provident Fund Department to deliver RGHS Card upto 31-05-2021. The period for enrollment can only be extended by competent authority on valid reasons. For new recruits the period of enrollment will be 3 months from the date of joining in service.
8. The enrollment forms for the all the categories will be available on RGHS website www.rghs.gov.in along with the procedure to fill such forms. The forms can be filled online only. Every persons of above mentioned category will be notified regarding enrollment with Unique RGHS Card Numbers. In case of misplacement of the card/ non availability of the card, this Unique RGHS Card Number can be used for taking treatment in the HCNP.
9. Empanelment of Private Hospitals, Diagnostic Laboratories, Imaging Centres and E-pharma Stores : The hospitals / diagnostic centres, imaging centres who have NABH / NABL accreditation and hospitals who have empanelment under CGHS will apply directly under RGHS on RGHS website. The hospitals and the diagnostic laboratories / imaging centres who do not possess NABH / NABL accreditation and also hospitals who are not empanelled under CGHS may apply on RGHS website i.e. www.rghs.gov.in as per the norms and criteria fixed by RGHS. The hospital/labs who have already empanelled by HBEC have to apply again online on RGHS website. The procedure and terms and conditions for e-pharma stores will be decided in due course.
10. State Insurance and Provident Fund Department (SIPF) will be nodal department and Finance (Insurance) Department will be Administrative Department for the Rajasthan Government Health Scheme.
11. The necessary amendments in concerned rules / schemes enlisted in para 2 will be issued in due course.
12. The Finance (Insurance) Department, shall issue detailed operational guidelines alongwith various annexures, circulars, clarifications, etc. for implementation of the RGHS. 13. If any difficulty arises in the course of implementation of this Scheme,
the concerned hospital / stake holder shall refer the matter to Director, State Insurance and Provident Fund Department and if the matter is not resolved at the level of Director, SIPF, then the decision of Finance (Insurance) Department shall be final. Appellate Authority shall be ACS / Principal Secretary, Finance.
By order of the Governor,
Principal Secretary, Finance
RGHS Registration Process